The Contrast Of Quality Of Life After Gastrectomy With Different Reconstruction Methods And Evaluation Of Pouch Function

There are lots of methods to reconstruct digestive track after gastric cancer operations. Especially after total gastrectomy, more then 60 methods were invited. The purpose of every kind of reconstructions and modified fashion were to reduce the symptoms after operations and to improve the Quality Of life ( QOL) of the patients. The objection of our study were to compare three kinds of reconstruction methods which were be used in our department, began with the follow up from the subject feeling of the patients, analyze the QOL of gastric cancer patients whom underwent different gastrectomy and reconstruction methods.To evaluate the function of the pouch, the patient' s subjective sensation were important aspect, and the objective examination were another considerable aspect. There are several method to exam those functions, and all those methods have their forte and defect. We use the method of isotope γ - Scintigraphy to detect the function of the reconstructed jujenal pouch of storage and control the drainage of solid food, compare the dififerences of empting times among the three kinds of reconstruction mode.Method一,The comparation of QOL of different reconstruction after gastrectomyFollow up the patients whom were operated in our department from 1999.5 to 2004.6. The total number of patients were 140, select 61 patients underwenttotal or proximal gastrectomy survived more than 12 months. Classification as follow; reconstructed with different pouch; proximal gastrectomy 13 cases; total gastrectomy: jejunal P pouch reconstruction 18 cases; total gastrectomy: jejunal Double - Braun reconstruction 30 cases, reconstructed with different passage; preserve duodenal passage 24 cases; without duodenal passage 37 cases. Collect the feedback information of questionary from those patients, based on the change of body weight, reflux of esophageal, times of eating and other 14 items, analyze the Quality Of Life among the different kinds of reconstruction pattern and different passages.二,The comparation of emptying time of different reconstruction methodsSelecte 19 patients whom were operated with total or proximal gastrectomy in our department. The ranges of the ages were 28 ~ 72 years old. All of the 19 patients were tumor free. Classification as follow; proximal gastrectomy 6 cases; total gastrectomy; jejunal P pouch reconstruction 7 cases; total gastrectomy; jejunal Double - Braun reconstruction 6 cases.Put in 1 mCi ~99Tc - DTPA to the meal we designed for the test, taken γ -Scintigraphy after patients ate the food immediately, collected one image every minute from the two interesting areas: the lower esophogal and where the pouch were reconstructed. The total image numbers are 90. Analyzing the data with computer, check the reflux sign in the lower esophogal and draw each of the Raw Data T 1/2 (min) and Linear Fit T 1/2 (min). Compare the Raw Data Tl/2 (min) among the three kinds of reconstruction mode, evaluate which of them have good functions in storaging and drainaging of solid food.Result一,The comparation of QOL of different reconstruction methods after gastrectomy1. Comparison of the reconstruction methods with different pouch: (3) 6 months after operation Reflux and body weight loss were common complain of those patients. The difference of the 14 items has no statistical mean-ings;d) 12 months after operation The QOL of patients of Double - Braun reconstruction methods were superior to the patients of proximal gastrectomy and P je-junal pouch in food intake frequence (P < 0. 05) , intake time ( P < 0. 05) and body weight gain (P <0.01);(D 24 months after operation, only body weight gain were better in Double - Braun reconstruction group than the other two groups (P <0.01).2. Comparison of the reconstruction methods with different passage;(1) 6 months after operation Reflux and body weight loss were common complain of those patients. The ratio of reflux has little differences between the two group, but no statistical meanings;(2) 12 months after operation The reconstruction method of without duodenal passage were superior to the patients of preserve duodenal passage in food intake frequence( P = 0, 040 < 0. 05 ) t intake time ( P = 0. 034 < 0. 05 ) and body weight gain (P=0.01);(§) 24 months after operation Only body weight gain were better in the group of without duodenal passage than in the group of preserve duodenal passage ( P < 0.01).JZ>The comparation of emptying time of solids among different reconstruction(J) Among the three kinds of reconstructions mode, no reflux image were found in the point of lower esophageaL? the Mean Raw Data T 1/2 ( min) of proximal gastrectomy (30.07min ± 15.77min) and P type reconstruction(27. 88min ±6.07min) were shorter compared with Double Braun reconstruction (51. 86min ± 6. 43min) , and the differences have significant statistics meaning (P =0.002 and P =0.001.(H) This phenomenon reveals that the stump stomach - esophageal anastomose and jejunal P pouch have poor functions in storaging and control drainaging of food. The Raw Data T 1/2 (min) and Linear Fit T 1/2 (min) of Double -Braun reconstruction are very near each other, show a good function in storing of food.@ Of the proximal gastrectomy and P type reconstruction, alone with the...